Jose Arreola’s parents told him at age five that he couldn’t speak Spanish in public, and couldn’t tell anyone where the family was from, or his mom and dad could be taken away.

Arreola missed being a U.S. citizen by about 48 hours, he told reporters with the Institute for Justice and Journalism at the Immigration in the Heartland conference in Oklahoma April 22. His mother was living in California at the time but traveled to Mexico two days before his birth, assuming at the time that it was where Arreola would be raised.

As a five-year-old he didn’t understand who would take his parents away or why, but he went to school every day fearing that he would never see them again. At school he kept to himself, because of his secret and also because, barred from speaking Spanish, at the time he couldn’t speak much English.

“I didn’t know who these people were but I knew someone was targeting us,” he said. “That feeling doesn’t go away.”

That’s the kind of mental and emotional stress that can be debilitating for children and have long-lasting effects on undocumented immigrants and U.S. citizen children of undocumented parents. The fear of deportation and the uncertainty of living in the shadows can likely cause and exacerbate serious mental health problems for immigrant families; an issue that is often overlooked among the many health challenges that face undocumented and mixed status immigrant families.

A 2011 paper in the Harvard Educational Review noted that: “The family’s unauthorized status entraps youth in a labyrinth of liminality that complicates the normative stages of development in multiple ways.” The paper notes that in early childhood, a child might not recognize the significance of the "secret taboo" of their immigration status. But as the child enters adolescence and beyond, they will increasingly find they are blocked from the coming-of-age rituals and other social acts that define their peer group. They are in long-term flux and isolation, inhibited from fully participating in U.S. society yet also separated from and forced to suppress the culture of their or their parents' native country.

And for many the slow-burn effects of being unauthorized in the U.S. are piled on top of the post traumatic stress disorder and other mental health impacts sparked by traumatic experiences suffered in coming to the U.S., including risky border crossings, victimization by smugglers or authorities and separation from home and family.

Arreola is now an outspoken advocate for “Dreamers” and other undocumented young people. He’s outreach and organizing director of the group Educators for Fair Consideration, or E4FC, which does political advocacy and provides legal and other resources for undocumented immigrants. In the near future the group will launch a mental health survey on its website, with questions to gauge the emotional well-being and mental health of respondents, and a structure to follow up with people in distress.

“We also want to get responses so we can show this is a significant issue in the community and we need more resources to address it,” Arreola said.

The National Immigrant Youth Alliance, led by undocumented youth, has also launched a project, Undocuhealth, focusing on the mental health needs of undocumented immigrants.

Arreola described the multiple ways that being undocumented affects one’s mental health. There is the constant fear and uncertainty, which is documented to take a toll in various ways – on mental health and other indicators like blood pressure. And then there are more subtle impacts.

“Just as human beings our number one emotional need is acceptance,” said Arreola. “If you’re undocumented from the get-go you’re not accepted. What does that do to one’s sense of agency?”

Then there’s the frustration of goals and hard work thwarted by the realities of being undocumented. For example Arreola received a scholarship offer to the University of San Diego, but was unable to attend since driving there from his home farther north would entail passing through an immigration checkpoint.

Also at the Immigration in the Heartland conference, held at the University of Oklahoma's Gaylord College of Journalism, sociologist Joanna Dreby described her multi-year research on the way children at specific schools in Ohio and New Jersey perceive being an immigrant. She found that a great number of children equated being “an immigrant” with being undocumented and hence being at constant risk of deportation. Children from immigrant families also identified immigrants as being “weird” and other negative connotations. Despite the fact that the U.S. is founded on immigration and most elementary schools teach this fact, she noted, children had the idea that being an immigrant in and of itself is something to be ashamed of. Likewise Mexican students were ashamed of their Mexican heritage, Dreby found. One can only imagine such perceptions will likely have long-ranging impacts on these children’s self-esteem and sense of identity and stability.

Dreby found that 25 percent of children from immigrant families in rural northeast Ohio felt isolated from their peers, and 9 percent in an urban district in New Jersey felt that way. In both places children told her that they didn’t want people to know that their parents were immigrants or from Mexico.

Dreby, an assistant professor at the State University of New York in Albany, also found that children had intense fears of their homes being raided and their family members being deported. The fears were based largely on media coverage. And while she didn’t quantify the level of risk facing the families she interviewed, the implication was that children’s fears were disproportionate to the actual level of risk their family faced. This meant, she suggested, that even if enforcement is made less aggressive, the psychological and social impacts could remain the same.

Arreola no longer lives in fear; he freely travels and speaks out about being undocumented. “I’m just at peace with whatever could happen, I know this is what I need to be doing,” he said.

He places himself in the tradition of “every group that’s had to fight so hard to be included in this country, to be recognized as human” – including slaves and Native Americans. “I’m proud to be part of that legacy.”

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